Sleep: Want It, Need It, Get It Donna Martinson, Geary County Fact Sheet Family and Consumer Sciences Agent

Sleep stays active throughout sleep, and each stage of Want It: Waking in the morning feeling sleep is linked to a distinctive pattern of elec- refreshed, renewed and invigorated is a good trical activity known as brain waves. Feeling indicator of an adequate quality and quantity rested and being able to function well depends of sleep. For some people, however, adequate on total sleep time and on how much of the sleep is seldom achieved. various stages of sleep a person gets each night. Need It: Sleep is a fundamental component Sleep is divided into two basic types: rapid of good health across the lifespan. It is both re- eye movement (REM) sleep and non-REM storative and protective. Individuals who do not sleep (with four different stages). Typically, have adequate sleep are more likely to experi- sleep begins with non-REM sleep, progress- ence attention and memory difficulties, daytime ing from stage 1 through stage 4. REM sleep sleepiness, lack of energy, and are at higher risk begins about 90 minutes after a person falls of falling or having a traffic accident. asleep, and cycles along with non-REM stages throughout the night. Inadequate sleep is associated with medical conditions, including heart and lung diseases, Stages 3 and 4 are considered deep sleep, high blood pressure, depression, stroke, diabe- during which it is very difficult to be awak- Table 1 tes, and obesity. Not getting enough sleep can lower metabolic function, compromise immu- Non-REM Sleep nity, be associated with cancer, increase sensi- Stage 1: Light sleep; easily awakened; muscle activity; tivity to pain and increase mortality. eye movements slow down. Stage 2: Eye movements stop; slower brain waves, with Get It: Nonstop lifestyles, stress, lack of occasional bursts of rapid brain waves. understanding about the health benefits of ad- Stage 3: Considered deep sleep; difficult to awaken; equate sleep, and the presence of sleep-related brain waves slow down more, but still have occasional problems are just a few of the reasons children rapid waves. and adults may fail to achieve adequate sleep. Stage 4: Considered deep sleep; difficult to awaken; Achieving adequate sleep may result from extremely slow brain waves. simple changes in routine, environment, diet REM Sleep and other factors. Sleep disorders are common, Usually first occurs about 90 minutes after falling and some are serious, but most can be treated. asleep; cycles along with the non-REM stages through- What is Sleep? out the night. Eyes move rapidly, with eyelids closed. Breathing is more rapid, irregular, and shallow. Heart Sleep has distinct stages that cycle through- rate and blood pressure increase. Dreaming occurs. Arm out the night in predictable patterns. The brain and leg muscles are temporarily paralyzed.

Kansas State University Agricultural Experiment Station and Cooperative Extension Service ened. Deep sleep is considered the “restorative” Table 2 part of sleep and is necessary for feeling well Life Stage and Sleep rested and energetic during the day. Life Stage Average number of hours Dreams occur during REM sleep. While of sleep needed dreaming, arm and leg muscles are temporarily Infants 16-18 paralyzed so the sleeper cannot act out dreams. Babies and Toddlers 12-14 Preschoolers 10-12 If REM sleep is disrupted during one Elementary School Age minimum 9 night, it is typically longer than normal in sub- Teenagers minimum 9 sequent nights until caught up. Adults 7-9 Infants spend half or more of their total sleep time in REM sleep. As a person matures, Hormonal influences shift adolescents’ bio- the percentage of total sleep time spent in REM logical clock. Teenagers are more likely to go decreases to about one-fifth of sleep time. to bed later than younger children and adults, It is known that REM sleep stimulates the and to sleep later in the morning. brain regions used in learning and the forma- From midlife through late life, people’s tion of memories. Studies show, however, that sleep is more interrupted by wakefulness dur- other stages of sleep are also important for ing the night. These interruptions decrease brain function. both the quantity and quality of sleep in adults. Dreams: Why people dream is not well un- Many older people complain of difficulty fall- derstood. Animal studies suggest that dreams ing asleep, early morning awakenings, frequent may reflect the brain’s sorting and selectively and long awakenings during the night, daytime storing important new information acquired sleepiness, and lack of refreshing sleep. Sleep while awake. During the time this informa- problems may be related to lifestyle or may re- tion is processed, the brain might revisit scenes sult from medical problems or the medications from the day while pulling up old memories. or treatments of those medical problems. This may be why childhood memories mingle Some evidence suggests that the biological with more recent events during dreams. clock shifts in older people, toward going to How Much Sleep Is Enough? sleep earlier at night and waking up earlier in Several factors determine how much sleep the morning. This does not mean older people is enough. can get by with less sleep than younger people. Healthy adults, when given unlimited op- Brain disorders such as Alzheimer’s disease portunity to sleep, will sleep on average between may also disrupt the body’s biological clock. eight and eight and one-half hours. But normal Quality vs Quantity: Both are important. sleep needs range from seven to nine hours. People whose sleep is frequently interrupted Sleep needs also change throughout the or cut short may not get enough of both non- lifecycle. Table 2 illustrates the amount of sleep REM sleep and REM sleep. Both types of a person generally needs to function well during sleep appear to be crucial for learning and the day. memory – and perhaps for the other restor- ative benefits of healthy sleep, including cell As people get older, the pattern of sleep also growth and repair. changes. For example, children spend more time in the deep sleep stages than do adults. Just one night of inadequate sleep can ad- 2 versely affect a person’s functioning and mood tific innovations have been associated with during at least the next day. Trying to make up adequate sleep. lost sleep on a weekend does not completely Memory: Sleep deprivation may interfere erase a person’s sleep deficit. with short-term, or working, memory which What Makes A Person Sleep? is involved in temporarily storing and manag- ing information. Sleep appears necessary for The daily need for sleep may be driven, at the acquisition of procedural memories, that is, least in part, by a naturally occurring com- memory of skills and procedures. pound called adenosine. It builds up in the blood while a person is awake. When a person Mood: Adequate sleep promotes optimal sleeps, the body breaks down the adenosine. brain performance for emotion control, deci- This molecule may help the body keep track sion-making and social interactions. Studies of lost sleep and trigger sleep when needed. consistently show that lack of sleep increases Because of such molecular feedback, a person irritability, volatility, and depression. cannot adapt to getting less sleep than the Immune system: The immune system’s pro- body requires. duction of cellular hormones called cytokines Another sleep trigger is a person’s “biologi- also influences a person’s need for sleep. Cyto- cal clock” – that is, the bundle of cells in the kines are compounds made in large quantities brain that respond to light signals received in response to certain infectious diseases or through the eyes. Darkness signals the bio- chronic inflammation and may prompt a per- logical clock to trigger the production of the son to sleep more than usual. The extra sleep hormone melatonin. This hormone increases may help conserve the resources needed to through the night, making a person feel fight the infection. Recent studies confirm that drowsy, with the greatest effect between mid- being well rested improves the body’s response night and 7 a.m. A second, milder, low may be to infection. in midafternoon, coinciding with another rise Obesity: Sleep deprivation alters hormones in melatonin. involved in appetite control and metabolism. The Sleep-Health Connection Inadequate sleep has been shown to drive down leptin levels, which regulate the feeling Brain at work: During sleep, the brain is of satisfaction after eating, and increases the at work forming pathways necessary for learn- hormone ghrelin, which stimulates appetite. ing, creating memories, and new insights. It The result of leptin decrease and ghrelin in- is thought that sleep has an adaptive function crease can be a nearly insatiable appetite, with that helps a person consolidate and fix memo- a desire for high-carbohydrate, calorie-dense ries and advance learning. foods. A good night’s sleep may be as essen- Inadequate sleep reduces a person’s ability tial to disease prevention and healthy weight to perform, think, concentrate, learn and react. maintenance as a nutritious diet. It increases anxiety, confusion, irritability and Digestive problems: Inadequate sleep can depression. Simple tasks can become difficult. cause problems such as constipation, diarrhea, An increased number of mistakes are made, in- excessive gas, abdominal pain, and heartburn. cluding misjudgments while driving. Heart, blood pressure, and stroke: Sleep Creative insights often occur during sleep. gives the heart and vascular system a much Creative problem-solving, artistic and scien- needed rest. If adequate rest is not achieved, 3 it might inhibit a dip in blood pressure that is Common Signs of a Sleep Disorder important for good cardiovascular health. If Following is a list of common signs of a blood pressure does not drop, a person is more sleep disorder. Consult a doctor if you have any likely to experience strokes, chest pain known of them: as angina, an irregular heartbeat, heart attacks, • It takes more than 30 minutes to fall and to develop congestive heart failure (fluid asleep at night. buildup in the body because the heart is not pumping sufficiently). • You awaken frequently in the night and then have trouble falling back to sleep. A lack of sleep puts the body under stress and may trigger the release of more adrena- • You awaken too early in the morning. line, cortisol, and other stress hormones during • You frequently don’t feel well rested de- the day. These hormones contribute to blood spite spending 7-8 hours or more asleep. pressure not dipping during sleep, thereby in- • You feel sleepy during the day and fall creasing the risk for heart disease. Inadequate asleep within 5 minutes if you have an sleep may also negatively affect the heart and opportunity to nap, or you fall asleep at vascular system by the increased production of inappropriate times during the day. proteins thought to play a role in heart disease. • Your bed partner claims you snore loudly, Some studies find that people who chronically snort, gasp, or make choking sounds while do not get enough sleep have higher blood you sleep. Or your partner notices your levels of C-reactive protein, which has been as- breathing stops for short periods. Such oc- sociated with a greater risk of developing hard- currences are symptoms of sleep apnea. ening of the arteries (atherosclerosis). • You have creeping, tingling, or crawling Hormones: Deep sleep triggers more re- feelings in your legs that are relieved by lease of growth hormone, which fuels growth moving or massaging them, especially in in children and boosts muscle mass and the re- the evening and when you try to fall asleep. pair of cells and tissues in children and adults. • While falling asleep or dozing, you have Sleep’s affect on the release of sex hormones vivid, dreamlike experiences. also relates to puberty and fertility. • You have episodes of sudden muscle Diabetes: A distinct rise and fall of blood weakness when you are angry, fearful, or sugar levels during sleep appears to be linked to when you laugh. sleep stage. Not getting enough sleep, or enough • You feel as though you cannot move when of each sleep stage disrupts this pattern. you first wake up. Cancer, lung diseases, sensitivity to pain, • Your bed partner notes that your legs or and increased mortality are other sleep-health arms jerk often during sleep. connections under study. • You regularly need to use stimulants to Microsleep, or very brief episodes of sleep stay awake during the day. in an otherwise awake person, can result from sleep deprivation. Microsleep that occurs while Note: Although children can show some of driving or working around machinery increases the same signs of a sleep disorder, they often the risk of accidents. do not show signs of excessive daytime sleepi- ness. Instead, they may seem overactive and have difficulty focusing and concentrating. 4 They also may not do their best in school. It is not later than 5 or 6 hours before bedtime. estimated that as many as 20 percent of chil- Avoid caffeine and nicotine. Coffee, colas, dren who have been diagnosed with attention certain teas, and chocolate contain the stimu- deficit hyperactivity disorder (ADHD) actually lant caffeine, and its effects can take as long have a sleep disorder. as 8 hours to wear off fully. Late afternoon or Snoring: Snoring occurs when air flows evening intake of caffeine can make it hard to past relaxed tissues in the throat, causing tis- fall asleep at night and increase the need to sues to vibrate as you breathe, creating hoarse void during the night. Nicotine is also a stimu- or harsh sounds. Factors leading to snoring lant, often causing smokers to sleep lightly. include mouth anatomy, alcohol consumption, Smokers often wake up too early in the morn- nasal problems, and sleep apnea. Snoring may ing because of nicotine withdrawal. indicate other health concerns such as obstruc- Avoid alcoholic drinks before bed. Al- tive sleep apnea, nasal obstruction or obesity. cohol robs a person of deep sleep and REM Parasomnias: Parasomnias are disruptive sleep, so sleep consists only of the lighter sleep-related disorders that can occur during stages. Also, after consuming alcohol a person arousals from REM sleep or partial arousals tends to wake up in the middle of the night from non-REM sleep. Parasomnias are char- when the effects of the alcohol have worn off. acterized by undesirable physical or verbal Alcohol increases the need to void during the behaviors, such as walking or talking during night. sleep. They occur in association with sleep, spe- Avoid large meals and beverages late at cific stages of sleep or sleep-wake transitions. night. A light snack is fine, but a large meal Other common roadblocks to sleep: A can cause indigestion that interferes with sleep. number of other conditions can compromise Drinking too many fluids at night can cause the ability of a person to get adequate sleep. frequent awakenings to urinate. A cup of warm These conditions include: depression or anxi- milk may shorten the time it takes to fall asleep. ety; need to urinate during the night (may be If possible, avoid medicines that delay due to an enlarged prostate in men or from or disrupt your sleep. Some commonly pre- cystitis in women); side effect of medica- scribed heart, blood pressure, or asthma medi- tion; hormonal changes (menopause); gastro- cations – as well as some over-the-counter esophageal reflux disease (or GERD); snoring medications and herbal remedies for coughs, partner; restless leg syndrome; inability to get colds, or allergies – can disrupt sleep patterns. comfortable because of pain; nighttime asth- Trouble sleeping should be discussed with a ma; clenching or grinding of teeth (bruxism). doctor or pharmacist to see if any drugs that Tips for Getting a Good Night’s Sleep are being taken might be contributing to in- somnia. Do not stop taking prescribed medica- Stick to a sleep schedule. Go to bed and tions without consulting your doctor. wake up at the same time each day. Sleeping late on weekends won’t fully make up for the Don’t take naps after 3 p.m. Naps do not lack of sleep during the week and will make it substitute for a good night’s sleep, but they can harder to awaken on Monday morning. be restorative and help counter some of the impaired performance that results from not Exercise, but not too late in the day. Try to getting enough sleep at night. Naps can help exercise at least 30 minutes on most days but you learn how to do certain tasks quicker. 5 Avoid taking naps later than 3 p.m., as late See a doctor if sleep problems persist. A naps can interfere with falling asleep at night. person who is consistently tired or not well Limit naps to one hour. Longer naps will make rested during the day, despite spending enough it harder to wake up and get back in the swing time in bed at night, might have a sleep disor- of things. Someone who takes frequent naps der. A family doctor or sleep specialist can help. during the day might have a sleep disorder. Sleep Centers Take a hot bath before bed. The drop in and Sleep Medicine Specialists body temperature after getting out of the bath contributes to feeling sleepy. Also, the bath can If your doctor refers you to a sleep center or help a person relax, slow down and become sleep specialist, make sure that center or spe- more ready to sleep. cialist is qualified to diagnose and treat sleep problems. To find sleep centers accredited by Have a good sleeping environment. Elim- the American Academy of Sleep Medicine, go inate noise, light or anything that might dis- to www.aasmnet.org and click on “Find a Sleep tract from sleep. Keep the room cool and have Center,” or call 708-492-0930. To find sleep a comfortable mattress and pillow. A television specialists certified by the American Board of or computer in the bedroom can be a distrac- Sleep Medicine, go to www.absm.org and click tion, so move them to another room. Use the on “Diplomates of the ABSM.” bedroom only for bedroom purposes. Sleep Medications Have the right sunlight exposure. Day- light is key to regulating daily sleep patterns. Use of sleep medications does not address Try to get outside in natural sunlight for at the sleep problem. Medications can create least 30 minutes each day. If possible, wake up dependency and intensify problems if abused, with the sun or use bright lights in the morn- misused, or taken too often. Read warning la- ing. Sleep experts recommend an hour of bels on all sleep medications. They should not exposure to morning sunlight to help attune be taken unless discussed first with your medi- the biological clock to the difference between cal professional. night and day. Don’t lie in bed awake. If still awake after lying in bed for more than 20 minutes, get up and do some relaxing activity until sleepy. The anxiety of not being able to fall asleep can make it harder to fall asleep. Relax. De-stress the mind and body by visualizing details of a relaxing scenario, or progressively tighten and relax your muscles from head to toe. Mentally “park” your worries outside the sleeping environment. Make lists of tasks to be done the next day before going to bed to lessen the fear of forgetting some- thing important. De-stressing rituals, such as meditation, can be useful.

6 Author References and Resources Donna R. Martinson , American Academy of Sleep Medicine One Westbrook Corporate Center, Suite 920 K-State Research and Extension – Geary Westchester, IL 60154 County, Family and Consumer Sciences, 708-492-0930 119 E. 9th, Junction City, KS 66441 www.aasmnet.org Phone: 785-238-4161 American Insomnia Association www.geary.ksu.edu www.americaninsomniaassociation.org E-mail: [email protected] American Sleep Apnea Association Reviewers: www.sleepapnea.org Narcolepsy Network, Inc. Suzanne Bollig, RRT, RPSGT, R EEG.T, www.narcolepsynetwork.org Manager, Sleep and Neurodiagnostics National Heart, Lung, and Blood Institute (NHLBI) Institute, Center for Health Improvement, www.ninds.nih.gov/disorders/restless_legs/ Hays Medical Center, Hays, Kan. detail_restless_legs.htm Andrew B. Crocker, Extension Program National Heart, Lung, and Blood Institute (NHLBI) Information Center – Your Guide to Healthy Sleep Specialist – Gerontology Health, Texas P.O. Box 30105 AgriLife Extension Service, Texas A&M System Bethesda, MD 20892-0105 Mary Sullivan, K-State Research and 301-592-8563 TTY: 240-629-3255 [email protected] Extension – Grant County, Family and www.nhlbi.nih.gov/sleep Consumer Sciences, Ulysses, Kan. National Sleep Foundation 1522 K Street, NW, Suite 500 Washington, DC 20005 Phone: 202-347-3471 [email protected] www.sleepfoundation.org Restless Legs Syndrome Foundation www.rls.org SLEEPLESS IN AMERICA Is Your Child Misbehaving or Missing Sleep?, Mary Sheedy Kurcinka, HarperCollinsPublishers, 2006 Whose kids? Our kids! Teens and Sleep, B3706-13,, AJ Schwichtenberg and Stephen Small, University of Wisconsin

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Kansas State University Agricultural Experiment Station and Cooperative Extension Service MF2830 August 2008 K-State Research and Extension is an equal opportunity provider and employer. Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended. Kansas State University, County Extension Councils, Extension Districts, and United States Department of Agriculture Cooperating, John D. Floros, Director.